Influence of gingivabiotype on aesthetics and possible manipulation of the biotype to enhance aesthetics.

The application of dental implants for single-tooth replacements in the maxillofacial aesthetic zone has evolved into a viable prosthodontic alternative to conventional fixed bridgework, resin-bonded restorations or removable partial dentures. Because of the high levels of survival, the focus of attention is moving from 'survival' to 'quality of survival' and the aesthetics are becoming the measure of success. The peri-implant soft tissue plays an important role. This involves the establishment of a soft tissue contour that is harmonious with the gingiva of the adjacent teeth. Unfortunately, a major concern in achieving harmonious aesthetics and an aesthetic final result is the peri-implant soft tissue recession of the mid-buccal mucosa after placing an implant.
According to several authors the aesthetic success of implant placement in terms of soft tissue recession is dependent on the gingival biotype. A thin gingival biotype is said to be more prone to recession of the mid-facial peri-implant mucosa. A thick biotype is said to result in a more predictable and satisfactory aesthetic result in harmony with neighbouring teeth.

Connective tissue grafting in combination with single implant placement and immediate provisionalization is reported to be able to convert a thin gingival biotype into a thick gingival biotype and in this way influencing predictability of the aesthetic outcome.

However, this type of treatment has been evaluated scarcely in combination with single tooth replacement and evidence from a randomized controlled clinical trial is missing.

It is hypothesized that placement of a single implant with tissue grafting will lead to less mid-facial soft tissue recession.

1. Aesthetics of the soft and hard tissue; Clinical peri-implant variables; Change in volume labial gingival; Change in bone resorption: 2 weeks before, 1month and 1year after implant placement;

2. Implant survival: 1 year after implant placement;

3. Patient satisfation: 2 weeks before and 1 year after implant placement.

For this study a single implant is placed in the extraction wound or in healed extraction sites and immediately restored with a screw-retained temporary crown. Depending on the studygroup the mid-buccal mucosa is manipulated by a tissue graft or nothing is done.